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Fractional flow reserve-guided complete revascularization versus culprit-only percutaneous coronary intervention in patients with myocardial infarction: A meta-analysis of randomized controlled trials.
Cardiovasc Revasc Med
December 2024
Department of Cardiovascular Medicine, Baystate Medical Center and Division of Cardiovascular Medicine, University of Massachusetts-Baystate, Springfield, MA, USA. Electronic address: https://twitter.com/AGoldsweig.
Introduction: The optimal revascularization strategy for patients with myocardial infarction (MI) and multivessel coronary artery disease (CAD) remains an area of research and debate. Fractional flow reserve (FFR)-guided complete revascularization (CR) by percutaneous coronary intervention (PCI) has emerged as an alternative to traditional culprit-only PCI.
Objective: To investigate the outcomes of FFR-guided CR versus culprit-only PCI in patients with MI and multivessel CAD.
Left Anterior Descending Nonculprit Lesions and Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction.
JACC Cardiovasc Interv
October 2024
Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada. Electronic address:
Article Synopsis
- The COMPLETE trial showed that complete revascularization in STEMI patients with multivessel disease leads to better health outcomes than treating only the culprit lesion.
- This subanalysis focused on whether having a nonculprit lesion (NCL) in the proximal/mid left anterior descending artery (LAD) affects outcomes compared to NCLs in other locations.
- Results indicated that while the presence of a proximal/mid-LAD NCL did not significantly alter treatment benefits, complete revascularization consistently reduced major cardiovascular events across both groups.
Complete revascularization versus culprit-only revascularization in older adults with ST-elevation myocardial infarction: Systematic review and meta-analysis of randomized controlled trials.
J Am Geriatr Soc
December 2024
Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Background: Randomized controlled trials (RCTs) of complete revascularization (CR) versus culprit-only revascularization (COR) in patients with ST-elevation myocardial infarction (STEMI) have shifted the recommendation for CR from class III to class I in the AHA/ACC/SCAI guidelines, but it remains unclear if the benefit of CR over COR extends to older adults, who have greater bleeding risk, comorbidity burden, and complexity of lesions. We performed a meta-analysis to place the results of the previous RCTs in the context of the recently published FIRE trial and the subgroup analysis of the COMPLETE trial in adults ≥75 years old.
Methods: We searched the literature from inception to October 21, 2023.
Complete myocardial revascularization, targeting both culprit and non-culprit coronary stenoses, is recommended by current guidelines in acute myocardial infarction (AMI) management, either during the index percutaneous coronary intervention (PCI) procedure or within 45 days, depending on the clinical context. However, in patients with chronic kidney disease (CKD), particularly end-stage kidney disease (ESKD), fractional flow reserve (FFR) presents unique challenges. Altered coronary physiology in CKD, such as arterial stiffness and microcirculatory dysfunction, affects FFR accuracy, complicating revascularization decisions.
View Article and Find Full Text PDFComplete versus culprit-only coronary revascularization in patients with myocardial infarction and multivessel disease undergoing percutaneous coronary intervention: an updated meta-analysis.
Panminerva Med
November 2024
Centro de Estudios en Cardiología Intervencionista (CECI), Buenos Aires, Argentina.
Introduction: Recently, the FFR-Guidance for Complete Nonculprit Revascularization (FULL REVASC) trial in ST elevation myocardial infarction (STEMI) patients with multiple vessel disease (MVD) did not show differences in the composite endpoint of death from any cause, myocardial infarction, or unplanned revascularization than culprit-lesion-only percutaneous coronary intervention (PCI) at 4.8 years, although complete revascularization is a recommendation IA in current guidelines. We want to determine through an updated meta-analysis whether complete revascularization is associated with decreased mortality and hard clinical endpoints compared to culprit lesion only PCI.
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